Life After Sutter

When news spread that Sutter Health (Sacramento, California) planned to cut loose its long-time radiology provider in Sacramento in favor of a captive model, some observers wondered how Radiological Associates of Sacramento (RAS), a 76-radiologist practice founded in 1917, would survive.

Not only has it sustained the blow, but not one partner has left to join the new hospital practice. Anyone who has heard the practice’s CEO, Fred Gaschen, MBA, speak at RBMA, ACR®, and RSNA meetings during the past decade knows that RAS has been preparing for this eventuality for a dozen years. Consequently, what could have been a devastating blow to another practice is merely cause for belt tightening at RAS. The story is a cautionary tale for all radiology private practices, in these times of change.

“In mid-October, we announced that a local medical-oncology group that was having some managerial and financial challenges was going to join RAS. Three weeks later, we got our letter of termination.”

RAS and Sutter Health should have spent 2009 negotiating a contract for coverage of five hospitals (Sutter Davis Hospital; Sutter Memorial Hospital and Sutter General Hospital, which are parts of Sutter Medical Center Sacramento; Sutter Roseville Medical Center; and Sutter Auburn Faith Hospital). The old contract expired March 31, 2010, but communications stopped completely in the fall of 2009, Gaschen reports.

“In mid-October, we announced that a local medical-oncology group that was having some managerial and financial challenges was going to join RAS,” Gaschen says. “Three weeks later, we got our letter of termination.”

Meanwhile, after notifying RAS that its contract would be allowed to expire, Sutter Health announced its intention to build an in-house practice. According to an article¹ in the Sacramento Business Journal, Sutter Health hired radiologist Patrick Browning, MD, to serve as chair of Sutter Medical Group’s Division of Medical Imaging, founded in January of this year. The article notes that as of April 1, Sutter Health had hired 12 of 21 planned radiologists, and it is using locum tenens and a national teleradiology provider to fill the gaps.

Gaschen believes that the point of departure for Sutter Health was competition in the outpatient market, where RAS operates 16 imaging centers.

According to Cecilia Hernandez, director of medical affairs at Sutter Medical Center Sacramento, the decision was about cost and quality. “The focus is to improve effectiveness, make us more affordable, and get quality outcomes,” she told the Sacramento Business Journal.

The same article quoted a March 5 letter to staff physicians sent by Tom Gagen, CEO at Sutter Medical Center Sacramento, reassuring physicians that the same level of quality would be met. “Our commitment as of April 1 is to provide at least the same level of coverage and quality as you have received in the past,” he wrote.

Breaking Up Is Hard

While the loss of Sutter Health represents a blow to income for RAS, the practice’s 16 freestanding imaging centers account for the vast majority of the group’s imaging volume, Gaschen says. “The impact of losing the hospitals was something we did not want to happen, but it is far from sounding a death knell, or even having a serious impact,” he states.

RAS is the sole provider of outpatient imaging and radiation-oncology services under a managed care contract with Hill Physicians in San Ramon (Northern California’s largest independent practice association, serving 300,000 covered lives). Hill Physicians provides inpatient services at Mercy General Hospital in Sacramento. Under the same contract, RAS is the designated provider of inpatient services at the Sacramento-area Sutter Health facilities.

RAS partners’ incomes inevitably will decline. “Nobody left, and we have less money, so physician salaries are going to go down,” Gaschen acknowledges.

Dissolving a long-term relationship that some track back to the 1920s is complicated, so in order to be as nondisruptive as possible, RAS radiologists have agreed not to go into the hospitals unless necessary, and instead, to have all studies transferred to their PACS. “There are certain procedures that must be done in the hospital,” Gaschen says. “One of the hospitals, Sutter Roseville Medical Center, is a trauma center. If there is a Sutter Physician Alliance patient at 2 am who needs interventional